Hypoxia and hypotension, the “lethal duo” in traumatic brain injury: implications for prehospital care

2007 ◽  
Vol 34 (3) ◽  
pp. 402-404 ◽  
Author(s):  
Philip F. Stahel ◽  
Wade R. Smith ◽  
Ernest E. Moore
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Prehospital Care

A humanização à vítima de traumatismo crânioencefálico: uma revisão narrativa

2021 ◽  
Vol 5 (9) ◽  
pp. 20-26
Author(s):  
Nithya Deyelly Batista Neves Guidão ◽  
Danielle Galdino de Souza
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Prehospital Care ◽  
Sample Selection ◽  
Cranial Trauma ◽  
Integration Of Services ◽  
Care Practices ◽  
Definition Of ◽  
Definition Of Information

O estudo objetivou a compreender a influência da humanização durante a assistência de enfermagem ao paciente com Traumatismo Crânioencefálico. Trata-se de revisão narrativa, percorridas em seis etapas: (1) estabelecimento da hipótese e objetivos da revisão; (2) estabelecimento de critérios de inclusão e exclusão de artigos (seleção da amostra); (3) definição das informações a serem extraídas dos artigos selecionados (4) avaliação dos resultados (5) interpretação dos resultados (6) apresentação da revisão. Foram analisadas 7 artigos, os enfermeiros devem atuar demonstrando sempre o anseio pela busca de aperfeiçoamento em suas práticas assistenciais, e uma estratégia que beneficia a equipe, bem como também, promover a humanização, e a estruturação de um protocolo com base científica que auxilia nas atividades seguras e eficazes ao vínculo profissional-paciente. Conclui-se que a humanização tem influência direta na qualidade assistencial dos pacientes com TCE por meio de um ambiente confortável, com gestão de recursos, maior atividade de profissionais de várias especialidades capacitados para avaliar, diagnosticar e iniciar o tratamento de forma imediata, gerando a organização e integração dos serviços que atendam a demanda de usuários nos setores de urgência e emergência.Descritores: Humanização, Urgência e Emergência, Atendimento Pré-Hospitalar, Traumatismo Craniano. Humanization to the victim of traumatic brain injury: a narrative reviewAbstract: The study aimed to understand the influence of humanization during nursing care for patients with traumatic brain injury. It is a narrative review, carried out in six stages: (1) establishment of the hypothesis and objectives of the review; (2) establishment of inclusion and exclusion criteria for articles (sample selection); (3) definition of information to be extracted from selected articles (4) evaluation of results (5) interpretation of results (6) presentation of the review. Seven articles were analyzed, nurses should always demonstrate their desire to seek improvement in their care practices, and a strategy that benefits the team, as well as promoting humanization, and the structuring of a scientifically based protocol that helps in safe and effective activities to the professional-patient bond. It is concluded that humanization has a direct influence on the quality of care for patients with TBI through a comfortable environment, with resource management, greater activity of professionals from various specialties trained to evaluate, diagnose and start treatment immediately, generating the organization and integration of services that meet the demand of users in the urgency and emergency sectors.Descriptors: Humanization, Urgency and Emergency, Prehospital Care, Cranial Trauma. Humanización a la víctima de traumatismo craneoencefálico: una revisión narrativaResumen: El estudio tuvo como objetivo comprender la influencia de la humanización durante el cuidado de enfermería para pacientes con traumatismo craneoencefálico. Se trata de una revisión narrativa, realizada en seis etapas: (1) establecimiento de las hipótesis y objetivos de la revisión; (2) establecimiento de criterios de inclusión y exclusión de artículos (selección de muestra); (3) definición de la información que se extraerá de los artículos seleccionados (4) evaluación de los resultados (5) interpretación de los resultados (6) presentación de la revisión. Se analizaron siete artículos, los enfermeros siempre deben demostrar su deseo de buscar la mejora en sus prácticas de cuidado, y una estrategia que beneficie al equipo, además de promover la humanización, y la estructuración de un protocolo de base científica que ayude en actividades seguras y eficaces para el vínculo profesional-paciente. Se concluye que la humanización tiene una influencia directa en la calidad de la atención al paciente con TCE a través de un ambiente confortable, con manejo de recursos, mayor actividad de profesionales de diversas especialidades capacitados para evaluar, diagnosticar e iniciar tratamiento de manera inmediata, generando la organización e integración de servicios que satisfagan la demanda de los usuarios en los sectores de urgencia y emergencia.Descriptores: Humanización, Urgencia y Emergencia, Atención Prehospitalaria, Trauma Craneal.

scholarly journals Prehospital management of traumatic brain injury

2008 ◽  
Vol 25 (4) ◽  
pp. E5 ◽  
Author(s):  
Shirley I. Stiver ◽  
Geoffrey T. Manley
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Intracranial Pressure ◽  
Prehospital Care ◽  
Major Determinant ◽  
Neurological Injury ◽  
Raised Intracranial Pressure ◽  
Long Term Outcome ◽  
Cerebral Herniation ◽  
Prehospital Management

The aim of this study was to review the current protocols of prehospital practice and their impact on outcome in the management of traumatic brain injury. A literature review of the National Library of Medicine encompassing the years 1980 to May 2008 was performed. The primary impact of a head injury sets in motion a cascade of secondary events that can worsen neurological injury and outcome. The goals of care during prehospital triage, stabilization, and transport are to recognize life-threatening raised intracranial pressure and to circumvent cerebral herniation. In that process, prevention of secondary injury and secondary insults is a major determinant of both short- and longterm outcome. Management of brain oxygenation, blood pressure, cerebral perfusion pressure, and raised intracranial pressure in the prehospital setting are discussed. Patient outcomes are dependent upon an organized trauma response system. Dispatch and transport timing, field stabilization, modes of transport, and destination levels of care are addressed. In addition, special considerations for mass casualty and disaster planning are outlined and recommendations are made regarding early response efforts and the ethical impact of aggressive prehospital resuscitation. The most sophisticated of emergency, operative, or intensive care units cannot reverse damage that has been set in motion by suboptimal protocols of triage and resuscitation, either at the injury scene or en route to the hospital. The quality of prehospital care is a major determinant of long-term outcome for patients with traumatic brain injury.

scholarly journals Prehospital and Emergency Care in Adult Patients with Acute Traumatic Brain Injury

2019 ◽  
Vol 7 (1) ◽  
pp. 12 ◽  
Author(s):  
Iris Pélieu ◽  
Corey Kull ◽  
Bernhard Walder
Keyword(s):  
Risk Factors ◽  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Emergency Care ◽  
Clinical Pathways ◽  
Prehospital Care ◽  
Clinical Diagnostics ◽  
Prehospital Treatment ◽  
Early Risk ◽  
Early Risk Factors

Traumatic brain injury (TBI) is a major healthcare problem and a major burden to society. The identification of a TBI can be challenging in the prehospital setting, particularly in elderly patients with unobserved falls. Errors in triage on scene cannot be ruled out based on limited clinical diagnostics. Potential new mobile diagnostics may decrease these errors. Prehospital care includes decision-making in clinical pathways, means of transport, and the degree of prehospital treatment. Emergency care at hospital admission includes the definitive diagnosis of TBI with, or without extracranial lesions, and triage to the appropriate receiving structure for definitive care. Early risk factors for an unfavorable outcome includes the severity of TBI, pupil reaction and age. These three variables are core variables, included in most predictive models for TBI, to predict short-term mortality. Additional early risk factors of mortality after severe TBI are hypotension and hypothermia. The extent and duration of these two risk factors may be decreased with optimal prehospital and emergency care. Potential new avenues of treatment are the early use of drugs with the capacity to decrease bleeding, and brain edema after TBI. There are still many uncertainties in prehospital and emergency care for TBI patients related to the complexity of TBI patterns.

scholarly journals Recommendations of the Colombian Consensus Committee for the Management of Traumatic Brain Injury in Prehospital, Emergency Department, Surgery, and Intensive Care (Beyond One Option for Treatment of Traumatic Brain Injury: A Stratified Protocol [BOOTStraP])

2020 ◽  
Vol 11 (01) ◽  
pp. 007-022
Author(s):  
Andres M. Rubiano ◽  
David S. Vera ◽  
Jorge H. Montenegro ◽  
Nancy Carney ◽  
Angelica Clavijo ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Emergency Department ◽  
Intensive Care ◽  
Brain Injury ◽  
Developing Economies ◽  
Prehospital Care ◽  
Real Life ◽  
Public Health Problem ◽  
Care Providers ◽  
Clinical Practices

Abstract Background Traumatic brain injury (TBI) is a global public health problem. In Colombia, it is estimated that 70% of deaths from violence and 90% of deaths from road traffic accidents are TBI related. In the year 2014, the Ministry of Health of Colombia funded the development of a clinical practice guideline (CPG) for the diagnosis and treatment of adult patients with severe TBI. A critical barrier to the widespread implementation was identified—that is, the lack of a specific protocol that spans various levels of resources and complexity across the four treatment phases. The objective of this article is to present the process and recommendations for the management of patients with TBI in various resource environments, across the treatment phases of prehospital care, emergency department (ED), surgery, and intensive care unit. Methods Using the Delphi methodology, a consensus of 20 experts in emergency medicine, neurosurgery, prehospital care, and intensive care nationwide developed recommendations based on 13 questions for the management of patients with TBI in Colombia. Discussion It is estimated that 80% of the global population live in developing economies where access to resources required for optimum treatment is limited. There is limitation for applications of CPGs recommendations in areas where there is low availability or absence of resources for integral care. Development of mixed methods consensus, including evidence review and expertise points of good clinical practices can fill gaps in application of CPGs. BOOTStraP (Beyond One Option for Treatment of Traumatic Brain Injury: A Stratified Protocol) is intended to be a practical handbook for care providers to use to treat TBI patients with whatever resources are available. Results Stratification of recommendations for interventions according to the availability of the resources on different stages of integral care is a proposed method for filling gaps in actual evidence, to organize a better strategy for interventions in different real-life scenarios. We develop 10 algorithms of management for building TBI protocols based on expert consensus to articulate treatment options in prehospital care, EDs, neurological surgery, and intensive care, independent of the level of availability of resources for care.

Doctor’s Knowledge and Practices of Traumatic Brain Injury Management in Chinese Prehospital Settings

2015 ◽  
Vol 30 (6) ◽  
pp. 560-568 ◽  
Author(s):  
Kou Kou ◽  
Xiang-Yu Hou ◽  
Jian-Dong Sun ◽  
Kevin Chu
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Prehospital Care ◽  
Hubei Province ◽  
Education Level ◽  
Ambulance Service ◽  
Knowledge Level ◽  
Injury Management ◽  
Incidence And Mortality ◽  
Training Frequency

AbstractObjectivesThe incidence and mortality of traumatic brain injury (TBI) has increased rapidly in the last decade in China. Appropriate ambulance service can reduce case-fatality rates of TBI significantly. This study aimed to explore the factors (age, gender, education level, clinical experience, professional title, organization, specialty before prehospital care, and training frequency) that could influence prehospital doctors’ knowledge level and practices in TBI management in China, Hubei Province.MethodsA cross-sectional questionnaire survey was conducted in two cities in Hubei Province. The self-administered questionnaire consisted of demographic information and questions about prehospital TBI management. Independent samples t-test and one-way ANOVA were used to analyze group differences in the average scores in terms of demographic character. General linear regression was used to explore associated factors in prehospital TBI management.ResultsA total of 56 questionnaires were handed out and 52 (93%) were returned. Participants received the lowest scores in TBI treatment (0.64; SD=0.08) and the highest scores in TBI assessment (0.80; SD=0.14). According to the regression model, the education level was associated positively with the score of TBI identification (P=.019); participants who worked in the emergency department (ED; P=.011) or formerly practiced internal medicine (P=.009) tended to get lower scores in TBI assessment; participants’ scores in TBI treatment were associated positively with the training frequency (P=.011); and no statistically significant associated factor was found in the overall TBI management.ConclusionThis study described the current situation of prehospital TBI management. The prehospital doctors’ knowledge level and practices in TBI management were quantified and the influential factors hidden underneath were explored. The results indicated that an appropriate continuing medical education (CME) program enables improvement of the quality of ambulance service in China.KouK, HouXY, SunJD, ChuK. Doctor’s knowledge and practices of traumatic brain injury management in Chinese prehospital settings. Prehosp Disaster Med. 2015;30(6):560–568.

Prehospital care of traumatic brain injury

2021 ◽  
pp. 77-83.e1
Author(s):  
Andrea L.C. Schneider ◽  
Geoffrey S.F. Ling
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Prehospital Care
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